Provider Demographics
NPI:1700106648
Name:SCHWARTZ, ANGELA BRADLEY (LAC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:BRADLEY
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 LOMBARD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-8231
Mailing Address - Country:US
Mailing Address - Phone:805-981-3666
Mailing Address - Fax:
Practice Address - Street 1:1851 LOMBARD ST STE 100
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-8231
Practice Address - Country:US
Practice Address - Phone:805-981-3666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13512171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist